Early Monday morning, Gov. Rick Perry (R) announced that Texas won’t create a state insurance exchange nor accept expanded Medicaid funds outlined in the Affordable Care Act. In a statement, Perry said, “Neither a ‘state’ exchange nor the expansion of Medicaid under this program would result in better ‘patient protection’ or in more ‘affordable care.'”

Perry’s announcement is an especially harmful move because Texas will benefit more from the Affordable Care Act than any other state. Texas was recently ranked worst in the country for health care delivery by the federal Agency for Health Care Research and Quality, scoring “weak” or “very weak” in nine of 12 categories. Perry’s office discounted the study as overly broad, and has argued that Texans’ real problem is personal health choices, not lack of health insurance.

More than 25 percent of Texans – 6,234,900 people – are uninsured, the highest rate in the nation. After five years of health reform, Texas would be able to insure 1,798,314 more Americans under the Medicaid expansion alone – more than any state in the nation. Setting up a state health insurance exchange would enable the remaining millions of uninsured Texans to purchase affordable health insurance. Thus, despite Perry’s claims, implementing the law would result in better patient protection and greater access to coverage.

Though the Supreme Court ruled that states can reject the expanded Medicaid funds without any penalty, any state that refuses to set up a health insurance exchange will have one set up for them by the federal government. This doesn’t lessen the impact of Perry’s decision to deny 1.8 million uninsured Texans the opportunity to be covered under Medicaid. He joins other Republican governors across the country in pledging to or considering turning down $258 billion in Medicaid funds and leaving 9.2 million Americans uninsured. A new study by the Brookings Institution found that states led by Republican governors have the most uninsured Americans, making political moves like Perry’s particularly harmful to Americans’ health.